The TBPod

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Dr Jyoti S. Mathad, Associate Professor of Medicine and Obstetrics & Gynaecology at Weill Cornell Medicine, to discuss tuberculosis infection, prevention and treatment during pregnancy. They explore the unique immunological changes that occur during pregnancy, why pregnant women are at increased risk of developing TB disease, and the challenges of generating evidence for TB preventive treatment in this population. Dr Mathad also reflects on her work advancing the inclusion of pregnant and lactating women in TB research, the growing evidence for shorter preventive treatment regimens, and the importance of building an evidence base that improves outcomes for both mothers and their infants.

Show Notes

• Cherkos A, LaCourse S, Enquobahrie D et al. Effect of pregnancy versus postpartum maternal isoniazid preventive therapy on infant growth in HIV-exposed uninfected infants: a post-hoc analysis of the TB APPRISE trial eClinicalMedicine, 2023; 58 
• DOLPHIN MOMS clinicaltrials.gov listing (unpublished) https://clinicaltrials.gov/study/NCT05122026
• Mathad JS, Savic R, Britto P, Jayachandran P, Wiesner L, Montepiedra G, Norman J, Zhang N, Townley E, Chakhtoura N, Bradford S, Patil S, Popson S, Chipato T, Rouzier V, Langat D, Chalermchockcharoentkit A, Kamthunzi P, Gupta A, Dooley KE. Pharmacokinetics and Safety of 3 Months of Weekly Rifapentine and Isoniazid for Tuberculosis Prevention in Pregnant Women. Clin Infect Dis. 2022 May 3;74(9):1604-1613. doi: 10.1093/cid/ciab665. PMID: 34323955; PMCID: PMC9070820.

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Dr Victoria Grey, infectious diseases physician in Brisbane, and Dr Jack Callum, respiratory physician in London, to explore the evidence behind the 12 month treatment duration for TB meningitis.

Together, they discuss the limited evidence underpinning current guidelines, the challenges of treating TB within the central nervous system, and emerging research examining whether shorter treatment regimens may be safe and effective. 

This episode concludes the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices.

Show Notes

• Jullien S, Ryan H, Modi M, Bhatia R. Six months therapy for tuberculous meningitis. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD012091. DOI: 10.1002/14651858.CD012091.pub2.
• Donovan J et al. A clinical practice guideline for tuberculous meningitis. Lancet Infect Dis. 2026 Feb;26(2):e96-e111. doi: 10.1016/S1473-3099(25)00364-0. Epub 2025 Aug 18. Erratum in: Lancet Infect Dis. 2025 Dec;25(12):e684. doi: 10.1016/S1473-3099(25)00660-7. PMID: 40840485; PMCID: PMC12419961.
• Sulis G et al. Comparative Effectiveness of Regimens for Drug-Susceptible Tuberculous Meningitis in Children and Adolescents: A Systematic Review and Aggregate-Level Data Meta-Analysis. Open Forum Infect Dis. 2022 Apr 9;9(6):ofac108. doi: 10.1093/ofid/ofac108. PMID: 35673608; PMCID: PMC9167638.

Dr Alice Sawka is joined by Dr Jack Callum, respiratory physician in London, and Dr Victoria Gray, infectious diseases physician in Brisbane, to explore the origins of the widely used “eight-hour rule” in TB contact tracing.

Together, they examine the evidence behind this commonly used threshold, trace its roots to early studies of TB transmission during air travel, and discuss how clinicians and public health teams assess exposure risk. They also explore the practical challenges of contact tracing and the “stone in the pond” approach used to identify those at greatest risk of TB infection.

This episode is the second in the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices.

Show Notes

Tuberculosis and air travel: guidelines for prevention and control – 3rd ed. “WHO/HTM/TB/2008.399” Available at: https://www.who.int/publications/i/item/9789241547505

Driver CR, Valway SE, Morgan WM, Onorato IM, Castro KG. Transmission of Mycobacterium tuberculosis associated with air travel. JAMA. 1994 Oct 5;272(13):1031-5. PMID: 8089885.

Kenyon TA et al. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N Engl J Med. 1996 Apr 11;334(15):933-8. doi: 10.1056/NEJM199604113341501. PMID: 8596593.

Migliori GB, et al. Reducing tuberculosis transmission: a consensus document from the World Health Organization Regional Office for Europe. Eur Respir J. 2019 Jun 5;53(6):1900391. doi: 10.1183/13993003.00391-2019. PMID: 31023852.

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Dr Jack Callum, respiratory physician in London, and Dr Victoria Grey, infectious diseases physician in Brisbane, to explore the evidence behind delaying TNF-alpha inhibitor therapy after starting TB preventive treatment. Together, they discuss the risk of TB reactivation with biologic therapies, the origins of current guideline recommendations, and how clinicians balance urgent immunosuppression with TB prevention in everyday practice. 

This episode is the first in the TB Origins series, exploring the evidence and history behind long-standing TB clinical practices.

Dr Alice Sawka, adult respiratory and TB physician in Adelaide, is joined by Courtney Murphy, a paediatric specialist TB nurse at Manchester University NHS Foundation Trust, to explore the challenges of diagnosing tuberculosis in children.

They discuss innovative approaches such as induced sputum, improving diagnostic yield and reducing invasive procedures, and the importance of microbiological confirmation and multidisciplinary care in paediatric TB. Courtney also reflects on introducing new clinical pathways within her service and the impact on time to diagnosis, as well as the importance of engaging families in treatment decisions.

Dr Martin Allen, Consultant Respiratory Physician at the University Hospital of North Staffordshire and National Clinical Lead for Respiratory Medicine within the GIRFT programme, joins Dr Jack Callum to discuss the development and impact of the GIRFT tuberculosis report across England and Scotland.

They explore how data-driven review and peer-led evaluations are uncovering gaps in TB care, from diagnostic delays to workforce challenges, and how these insights are driving local and national improvement. Dr Allen also reflects on translating recommendations into practice and the importance of shared learning across services as TB rates rise post-COVID.

Dr Padmasayee Papineni, Consultant and Co‑Clinical Director in Infectious Diseases at London North West University Healthcare NHS Trust, joins Dr Jack Callum to discuss the lived experience of tuberculosis care through narrative medicine. The conversation centres on her 2022 Lancet Wakley Prize–winning essay “Directly Observed Therapy,” which follows socially vulnerable patients navigating TB alongside poverty, migration, and precarious housing.

Dr Papineni challenges narrow, paternalistic interpretations of directly observed therapy, arguing instead for a model grounded in compassion, social support, and multidisciplinary care, and reflects on how storytelling can restore humanity to statistics-driven global health narratives.

Dr Peter MacPherson, Professor of Global Public Health at the University of Glasgow, joins Dr Jack Callum to discuss his research on HIV–TB care and shifting TB epidemiology. He discusses findings from the SaDAPT trial, showing that same‑day ART initiation for people with HIV and TB symptoms is non‑inferior to waiting for TB results and carries similarly low IRIS risk, supporting flexible, program‑level decision‑making. He also highlights his urban–rural TB prevalence meta‑analysis, revealing substantial regional variation and a global trend toward urbanization of TB, with implications for targeted screening and policy. Dr MacPherson reflects on the need for better, low‑cost TB surveillance tools and describes ongoing work on MTB immunoreactivity–based transmission mapping and advances in CAD‑supported TB diagnosis.

Dr Joseph Donovan, clinical researcher at OUCRU Vietnam and Associate Research Fellow at the University of Oxford, joins Dr Angus Lane, medical registrar to discuss the global burden and diagnostic challenges of tuberculosis meningitis (TBM). He outlines key findings from major trials in Vietnam and Indonesia, including the ACT HIV trial of adjunctive dexamethasone, discusses global practice guidelines, and highlights existing and emerging evidence on antiretroviral timing, aspirin, and rifampicin. Dr Donovan also reflects on the severe neurological complications of TBM and the need for evidence-based critical-care strategies worldwide.

Catherine Berry, ACTnet Steering Committee member and ID physician at John Hunter Hospital, Newcastle, was joined by Dr Jodie Schildkraut and Dr Van Le Hong, key researchers in the global Unite4TB consortium, which is accelerating the development of new TB treatments.

Dr Schildkraut, based at Radboud University Medical Center, leads the Phase 2B/C clinical trials work package and coordinates across multiple TB consortia. Dr Van Le Hong, a pulmonologist and clinical research fellow at OUCRU Vietnam, heads the multi-arm, multi-stage (MAMS) trial platform in Ho Chi Minh City.

Together, they explore Unite4TB’s approach to transforming TB regimen development, strengthening trial platforms, advancing biomarkers, improving early-phase design, and harmonising global research efforts, while reflecting on the practical challenges of conducting trials in high-burden settings.